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NUR 2790 Final Exam
CHAPTER 51: CARE OF PATIENTS WITH MUSCULOSKELETAL TRAUMA (
MULTIPLE CHOICE
1. A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment should alert the nurse to urgently contact the health
provider?
a. Blood pressure increases to 130/86 mm Hg
b. Traction weights are resting on the floor
c. Oozing of clear fluid is noted at the pin site
d. Capillary refill is less than 3 seconds
ANS: B
The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health care provider must be notified that the weights were
lying on the floor, and the client should be realigned in bed. The clients blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting
from lack of pressure to reduce the fracture. Oozing of clear fluid is normal, as is the capillary refill time.
Weights should not be removed without a prescription. They should not be lifted manually or allowed to rest on the floor. Weights should be freely hanging at all
times. Inspect the skin Q8H for S/S of irritation or inflammation. Remove the belt or boot that is used for skin traction Q8H to inspect under the device.
2. A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive
personnel (UAP)?
a. Assess distal pulses for potential compartment syndrome.
b. Turn the client every 3 to 4 hours to promote cast drying.
c. Use a cloth-covered pillow to elevate the clients leg.
d. Handle the cast with your fingertips to prevent indentations.
ANS: C
When delegating care to a UAP for a client with a wet plaster cast, the UAP should be directed to ensure that the extremity is elevated on a cloth pillow instead of a
plastic pillow to promote drying. The client should be assessed for impaired arterial circulation, a complication of compartment syndrome; however, the nurse should
not delegate assessments to a UAP. The client should be turned every 1 to 2 hours to allow air to circulate and dry all parts of the cast. Providers should handle the
cast with the palms of the hands to prevent indentations.
3. A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may
impede healing of the fracture?
a. Sedentary lifestyle
b. A 30 pack-year smoking history
c. Prescribed oral contraceptives
d. Pagets disease
ANS: D
Pagets disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing
but may cause other health risks.
Causes of Pathological Fractures:
• Osteogenesis imperfecta
• Rickets
• Osteomalacia
• Osteoporosis
• Hyperparathyroidism
• Cushing’s syndrome
• Paget’s disease: a chronic form of osteitis (osteitis deformans) of unknown cause affecting older people, causing thickening and hypertrophy (enlargement)
of the long bones and deformity of the flat bones
• Neoplasms
• Cystic bone disease
• Primary benign bone tumor
• Primary malignant bone tumor
• Infection
• Irradiation
4. An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg.
Which action should the nurse take first?
a. Assess the pedal pulses.
b. Apply oxygen by nasal cannula.
c. Increase the IV flow rate.
d. Loosen the traction.
ANS: A
These symptoms represent early warning signs of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede
changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be
obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never be loosened without a providers prescription.
Acute Compartment Syndrome: condition in which increased pressure within one or more compartments reduces circulation to the area (commonly in the lower leg
tibial fractures and forearm)
• Can begin 6 to 8 hrs after an injury or take up to 2 days to appear
5. A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital
signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?
a. Administer oxygen via nasal cannula.
b. Re-position to a high-Fowlers position.
, c. Increase the intravenous flow rate.
d. Assess response to pain medications.
ANS: A
The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening
emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral
damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Sitting the client in a high-Fowlers position will
not decrease hypoxia related to a fat embolism. The IV rate is not related. Pain medication most likely would not cause the client to be restless.
Fat Embolism Syndrome (FES): a fracture complication in which fat globules are released from the yellow bone marrow into the bloodstream within 12 to 48 hrs after
an injury
• Hip fracture patients are at highest risk (24 to 72 hrs after injury or surgery)
• 95% of FE come from the long bones
• May be misdiagnosed as a PE from a blood clot
• Early S/S: hypoxemia, dyspnea, tachypnea
• Later S/S: headache, lethargy, agitation, confusion, decreased LOC, seizures, vision changes, retinal hemorrhage, mild thrombocytopenia
• Last S/S: petechiae (macular, measles-like rash) classic manifestation
• Treatment: bedrest, gentle handling, oxygen, IV hydration, steroid therapy, fracture immobilization
6. A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis?
a. An 18-year-old male athlete with a fractured clavicle
b. A 36-year old female with type 2 diabetes and fractured ribs
c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis
d. A 74-year-old man who smokes and has a fractured pelvis
ANS: D
Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has
additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis
(stasis of blood caused by venous congestion), prolonged immobility, surgical procedure longer than 30 mins, cancer or chemotherapy, and heart disease. The other
clients do not have risk factors for DVT.
7. A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene care for
this client?
a. Remove the traction when re-positioning the client.
b. Inspect the clients skin when performing a bed bath.
c. Provide pin care by using alcohol wipes to clean the sites.
d. Ensure that the weights remain freely hanging at all times.
ANS: D
Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on the floor. The client should remain in traction during
hygiene activities. The nurse should assess the clients skin and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.
8. A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next?
a. Immobilize the left arm.
b. Assess the clients distal pulse.
c. Monitor for signs of infection.
d. Administer prescribed steroids.
ANS: A
A grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the
nurse should immobilize the clients arm and tell the client not to move the arm. The grating sound does not indicate circulation impairment or infection. Steroids
would not be indicated.
9. A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express
concerns for client safety?
a. Meperidine (Demerol) 50 mg IV every 4 hours
b. Patient-controlled analgesia (PCA) with morphine sulfate
c. Percocet 2 tablets orally every 6 hours PRN for pain
d. Ibuprofen elixir every 8 hours for first 2 days
ANS: A
Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause seizures. The nurse should question this prescription. The
other prescriptions are appropriate for this clients pain management.
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (Beers List): guidelines to help improve the safety of prescribing medications for
older adults
• Meperidine (Demerol), opioid analgesic, appears on the Beers List (morphine is recommended instead)
• PCA w/ morphine, fentanyl, or hydromorphone (Dilaudid) is recommended for pts w/ severe or multiple fractures
• Common oral opioids for fracture pain include oxycodone, Percocet (oxycodone w/ acetaminophen), and Norco (hydrocodone w/ acetaminophen)
• NSAIDs are given to decrease tissue inflammation but may slow bone healing
• Strong analgesics should be given before dressing changes, after PT sessions, and at bedtime
• Administer stool softener PRN for opioid-related constipation
10. A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse
respond?
a. The pain you are feeling does not actually exist.
b. This type of pain is common and will eventually go away.
c. Would you like to learn how to use imagery to minimize your pain?
d. How would you describe the pain that you are feeling?
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